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Sedation during Endoscopy

Every available means to ensure the safety of patients during endoscopic procedures is compulsory. The thorough preparation of the unit to handle endoscopic procedures and potential adverse outcomes is mandatory. Appropriate patient preparation, skilled assistants, and monitoring of the patient's well-being before, during and after the procedure ensures that endoscopic examinations can be carried out safely.

The maintenance of airway and cardio-respiratory equilibrium during sedated endoscopic examination requires dedicated medical personnel adapt at advanced airway and resuscitation skills. This is the sedationist/anaesthetist. The sedationist is responsible for allowing the procedure to occur in a safe manner.

A pre-procedural assessment is conducted prior to the sedation. This is aided by the medical checklist that patients are requested to complete. Endoscopic sedation is defined by the individualised titration of sedative hypnotic drugs and analgesic agents. The relative risks involved can then be estimated combining patient and procedural factors. Monitoring during endoscopic procedures is dependent upon a thorough understanding and assessment of the risk to the patient.

Familiarity of the pharmacological property of the agents used and also of the procedure allows for optimal use of sedative agents to ensure deep sedation without rendering apnoea.

Fasting rule of four hours is used to reduce the risk of aspiration of stomach content during the procedure.

Recovery is in two stages. The first is complete when the patient is awake and the blood pressure is stable. This may require additional intravenous fluid therapy. During the second stage the patient regains all their usual bodily functions, however, may still be drowsy and often will have variable amnesia lasting 2-4 hours.

Therefore, adherence to the post procedure instruction of not driving is of significant importance.